STENTING OF AORTOPULMONARY COLLATERALS IN COMPLEX PULMONARY ATRESIA

Background The optimal treatment of patients with complex pulmonary at resia remains controversial. Surgical unifocalization programs are inc reasing popular but have not previously or currently gained universal acceptance. Furthermore, not all patients are suitable for attempts at biventricular correction. These patients may become increasingly symp tomatic and require palliation. Methods and Results We attempted to pa lliate 12 patients with progressive symptomatic hypoxemia. Each had at least one stenotic but balloon-dilatable collateral supplying at leas t three lung segments. It was impossible to traverse the stenotic area with the stent in 1 patient, despite two attempts. Twelve stents were thus deployed in 11 patients. There was no effect in 1 patient who ha d multiple stenoses distal to the stented area. There was excellent pa lliation in the remainder, arterial oxygen saturation 45% to 79% befor e stenting (mean, 64+/-12%) rising to 67% to 90% (mean, 78+/-10%, P<.0 1) at discharge from hospital. One patient was referred for surgery to secure blood flow to a nearly totally occluded side branch to the rig ht upper lobe traversed by the stent. There was an excellent symptomat ic response in the remainder, with an early increase in exercise durat ion (P<.01). Late arterial desaturation occurred in 2 patients. In 1, there was pulmonary arterial hypertension in the lung segments supplie d by the stented vessel. A stenosis had developed within the stent in the other patient, who was noncompliant with anticoagulation therapy. Conclusions Stenting of stenotic aortopulmonary collaterals can achiev e excellent palliation in the majority of this highly selected subgrou p of patients with complex pulmonary atresia.